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Screening and Management of the Hyperandrogenic Adolescent ACOGCOMMITTEEOPINION Number 789 Committee on Adolescent Health Care This Committee Opinion was developed by the American College of Obstetricians and Gynecologists’ Committee on Adolescent Health Care in collaboration with committee members Jennie Yoost, MD and Ashlyn Savage, MD. Screening and Management of the Hyperandrogenic Adolescent ABSTRACT: Although androgen excess can manifest in many ways, the most common and recognizable (...) of PCOS and those of normal puberty,whichmakesthediagnosisofPCOSintheadolescentdifficult.Treatmentofacneandhirsutismshould not be withheld during the ongoing longitudinal evaluation for possible PCOS. On physical examination, body mass index, blood pressure, and signs of hyperandrogenism, such as acne and hirsutism, should be evaluated. Although guidelines differ on recommended laboratory studies, most include measurement of total testoster- one, free testosterone, or both, and screening
The screening and management of newborns at risk for low blood glucose Hypoglycemia in the first hours to days after birth remains one of the most common conditions facing practitioners across Canada who care for newborns. Many cases represent normal physiologic transition to extrauterine life, but another group experiences hypoglycemia of longer duration. This statement addresses key issues for providers of neonatal care, including the definition of hypoglycemia, risk factors, screening (...) protocols, blood glucose levels requiring intervention, and managing care for this condition. Screening, monitoring, and intervention protocols have been revised to better identify, manage, and treat infants who are at risk for persistent, recurrent, or severe hypoglycemia. The role of dextrose gels in raising glucose levels or preventing more persistent hypoglycemia, and precautions to reduce risk for recurrence after leaving hospital, are also addressed. This statement differentiates between
Recommendation on screening adults for asymptomatic thyroid dysfunction in primary care Recommendation on screening adults for asymptomatic thyroid dysfunction in primary care | CMAJ Main menu User menu Search Search for this keyword Search for this keyword Guideline Recommendation on screening adults for asymptomatic thyroid dysfunction in primary care Richard Birtwhistle , Kate Morissette , James A. Dickinson , Donna L. Reynolds , Marc T. Avey , Francesca Reyes Domingo , Rachel Rodin (...) of Family Medicine and Community Health Sciences (Dickinson), University of Calgary, Alta.; Dalla Lana School of Public Health and Department of Family and Community Medicine (Reynolds), University of Toronto, Ont.; Department of Psychiatry (Thombs), Jewish General Hospital and McGill University, Montréal, Que. KEY POINTS The Canadian Task Force on Preventive Health Care strongly recommends against screening for thyroid dysfunction in asymptomatic nonpregnant adults. Screening for thyroid dysfunction
Summary of Cervical Cancer Screening Recommendations for Non-HIV Immunocompromised Women (current immunosuppressants are listed in Table 2). Women with RA and IBD not on immunosuppressants and women with DM were considered at no increased risk compared with the general population. Screening recommendations based on these risks are summarizedinTable3. REFERENCES 1. GrulichAE,vanLeeuwenMT,FalsterMO,etal.Incidence ofcancersin peoplewithHIV/AIDScomparedwithimmunosuppressedtransplant recipients (...) . If resultofcytologyisnormalandHPVisnegative,co-testingcanbe performedevery 3 y -Iftransplantbefore theage of21y, begin screening within1 yofsexualdebut -Continue screeningthroughout lifetime (older than 65y). Discontinue screeningbasedonshareddiscussionregardingqualityand durationoflife rather thanage -Screenpatientsondialysis and posttransplantsimilarly Allogeneichematopoietic stem cell transplant -Cytologyisrecommendedifyounger than 30y -Co-testingispreferred, but cytologyisacceptableif 30yorolder -Ifusing cytologyalone, perform
Sequential screening for lung cancer in a high-risk group: randomised controlled trial: LungSEARCH: a randomised controlled trial of Surveillance using sputum and imaging for the EARly detection of lung Cancer in a High-risk group Low-dose computed tomography (LDCT) screening detects early-stage lung cancer and reduces mortality. We proposed a sequential approach targeted to a high-risk group as a potentially efficient screening strategy.LungSEARCH was a national multicentre randomised trial (...) . Current/ex-smokers with mild/moderate chronic obstructive pulmonary disease (COPD) were allocated (1:1) to have 5 years surveillance or not. Screened participants provided annual sputum samples for cytology and cytometry, and if abnormal were offered annual LDCT and autofluorescence bronchoscopy (AFB). Those with normal sputum provided annual samples. The primary end-point was the percentage of lung cancers diagnosed at stage I/II (nonsmall cell) or limited disease (small cell).1568 participants were
Effect of Mailed Human Papillomavirus Test Kits vs Usual Care Reminders on Cervical Cancer Screening Uptake, Precancer Detection, and Treatment: A Randomized Clinical Trial In the United States, more than 50% of cervical cancers are diagnosed in underscreened women. Cervical cancer screening guidelines now include primary human papillomavirus (HPV) testing as a recommended strategy. Home-based HPV self-sampling is a viable option for increasing screening compliance and effectiveness; however (...) , US data are needed to inform health care system implementation.To evaluate effectiveness of mailed HPV self-sampling kits vs usual care reminders for in-clinic screening to increase detection and treatment of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and uptake of cervical cancer screening.Randomized clinical trial conducted in Kaiser Permanente Washington, a US integrated health care delivery system. Women aged 30 to 64 years with health plan enrollment for 3 years and 5 months
Screening for thyroid dysfunction and treatment of screen-detected thyroid dysfunction in asymptomatic, community-dwelling adults: a systematic review This systematic review was conducted to inform the Canadian Task Force on Preventive Health Care recommendations on screening for thyroid dysfunction (TD). The review sought to answer key questions on the benefits and harms of screening for TD, patients' values and preferences for screening, and the benefits and harms of treating screen-detected (...) TD.This review followed Canadian Task Force on Preventive Health Care methods, which include the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The search strategy used for benefits and harms of screening and treatment was an update to the 2014 review by the US Preventive Services Task Force and searched MEDLINE and the Cochrane Library. MEDLINE, Embase, ProQuest Public Health, and SCOPUS were searched for patients' values and preferences for screening. Outcomes
Effectiveness of patient-targeted interventions to increase cancer screening participation in rural areas: A systematic review Cancer is a major public health problem worldwide. The GLOBOCAN estimated 18.1 million new cases of cancer and 9.6 million deaths from cancer in 2018. In some of the more frequent cancers, mortality can be significantly reduced through cancer screening programs. Nevertheless, socially disadvantaged groups have difficulties in benefitting from these screening programs (...) , especially rural populations.To identify, characterize and summarize patient-targeted interventions aimed at increasing cancer screening participation among rural populations.An exhaustive literature search was performed in the most relevant bibliographic databases for biomedical research. The systematic review was reported according to the PRISMA guidelines.Twenty studies assessing 37 interventions were identified. Most of the studies were conducted in the United States and targeted women. Ninety-seven
Impact of methodological approaches in the agreement between subjective and objective methods for assessing screen time and sedentary behavior in pediatric population: a systematic review. Introduction: sedentary behavior is an important target for health promotion. In this systematic review, we aimed to provide evidence to support decisions about measurement approach choices for subjectively assessing sedentary behavior in pediatric population, adopting objective methods as the reference (...) is registered in the PROSPERO database (CRD42014015138). Results: a total of 14 studies met the inclusion criteria with ages ranging from 3 to 17.5 years and provided 17 agreement analyses. Thirteen of these agreement analyses (76.5%) reported correlation coefficients. We found two major groups of sedentary activities: screen time (47.1%) and sedentary behaviors (52.9%). The pooled agreement between questionnaires and accelerometers for assessing self-reported screen time was negative (r = -0.15; CI 95
Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients.In this multicenter, randomized, controlled trial in the Netherlands, we assigned 40,373 women between the ages of 50 and 75 years with extremely dense (...) breast tissue and normal results on screening mammography to a group that was invited to undergo supplemental MRI or to a group that received mammography screening only. The groups were assigned in a 1:4 ratio, with 8061 in the MRI-invitation group and 32,312 in the mammography-only group. The primary outcome was the between-group difference in the incidence of interval cancers during a 2-year screening period.The interval-cancer rate was 2.5 per 1000 screenings in the MRI-invitation group and 5.0
Risk of Cervical Dysplasia After Colposcopy Care and Risk-Informed Return to Population-Based Screening: A Systematic Review. This systematic review examined the risk of cervical dysplasia among women who have undergone a colposcopy episode of care to inform their return to population-based cervical screening. PubMed, Embase, and grey literature were searched between January 2000 and 2018. One reviewer screened citations against pre-defined eligibility criteria. A second reviewer verified 10 (...) % and 100% of exclusions at title and abstract and at full-text screening, respectively. One reviewer extracted data and assessed methodological quality of included articles; a second reviewer verified these in full. The primary outcome was incidence of cervical intraepithelial neoplasia grade 2 or greater (CIN2+) subsequent to initial colposcopy evaluation. Secondary outcomes included incidence of CIN2+ after negative follow-up test results and performance of follow-up strategies. Results were
The diagnostic accuracy of brief screening instruments for problem gambling: A systematic review and meta-analysis. Non-gambling specialist services, such as primary care, alcohol and other drug use, and mental health services, are well placed to enhance the identification of people with gambling problems and offer appropriate generalist first level interventions or referral. Given time and resource demands, many of these clinical services may only have the capacity to administer very short (...) screening instruments. This systematic review was conducted to provide a resource for health service providers and researchers in identifying the most accurate brief (1-5 item) screening instruments to identify problem and at-risk gambling for their specific purposes and populations. A systematic search of peer-reviewed and grey literature from 1990 to 2019 identified 25 articles for inclusion. Meta-analysis revealed five of the 20 available instruments met criteria for satisfactory diagnostic accuracy
Usefulness of ultrasound fetal anthropometry in primary and secondary screening to identify small for gestational age: A meta-analysis. This study was performed to evaluate the usefulness of ultrasound fetal anthropometry in primary and secondary screening to identify small for gestational age (SGA).Ten databases, for example, PubMed (MEDLINE), were searched to include all English-language studies published since 2015 that provided true-positive and false-positive and true-negative and false (...) -negative results of SGA identification. A bivariate diagnostic meta-analysis was performed to summarize the sensitivity and specificity as well as positive and negative likelihood ratios (PLR and NLR, respectively) of ultrasound fetal anthropometry for identification of SGA.Sensitivity and NLR are important in primary screening. Both femur length and anthropometric formulas showed low sensitivity, although abdominal circumference showed moderate sensitivity. Abdominal circumference, femur length
Screening for oropharyngeal dysphagia in older adults: A systematic review of self-reported questionnaires. Oropharyngeal dysphagia is a swallowing disorder with signs and symptoms which may be present in older adults, but they are rarely noticed as a health concern by older people. The earliest possible identification of this clinical condition is needed by self-reported population-based screening questionnaire, which are valid and reliable for preventing risks to nutritional status, increased (...) morbidity and mortality.The aim of this systematic review was to identify self-reported screening questionnaires for oropharyngeal dysphagia in older adults to evaluate their methodological quality for population-based studies.An extensive search of electronic databases (PubMed (MEDLINE), Ovid MEDLINE(R), Scopus, Cochrane Library, CINAHL, Web of Science (WOS), PsycINFO (APA), Lilacs and Scielo) was conducted in the period from April to May 2017 using previously established search strategies by the two
Corrigendum to "Chlamydia trachomatis screening in preterm labor: A systematic review and meta-analysis" [Eur. J. Obstet. Gynecol. Reprod. Biol. 240 (September) (2019) 242-247]. 31679805 2019 11 20 1872-7654 243 2019 12 European journal of obstetrics, gynecology, and reproductive biology Eur. J. Obstet. Gynecol. Reprod. Biol. Corrigendum to "Chlamydia trachomatis screening in preterm labor: A systematic review and meta-analysis" [Eur. J. Obstet. Gynecol. Reprod. Biol. 240 (September) (2019) 242
American Urogynecologic Society Systematic Review: Microscopic Hematuria as a Screening Tool for Urologic Malignancies in Women. Most causes of microscopic hematuria (MH) are benign but may indicate an underlying malignancy. Current MH evaluation guidelines are reflective of male urologic malignancy risks. The objective of this systematic review was to evaluate whether the finding of MH predicts subsequent urologic malignancy in women.MEDLINE was searched between January 1990 and June 8, 2018 (...) . The positive predictive value (PPV) of MH as a screening tool for urologic malignancy was calculated for each study individually and collectively. The pooled relative risk of urologic malignancy associated with MH was calculated.Seventeen studies were included. Eight studies included only women. In total, 300 urinary tract cancers were identified in 110,179 women with MH. The PPV of MH as a screening tool for cancer ranged from approximately 0.6% to 2.8%; confidence intervals (CIs) suggested
Ways to use interventions to increase participation in mail-out bowel cancer screening: a systematic review and meta-analysis. The impact of colorectal cancer can be reduced through nationwide fecal occult blood test (FOBT) screening. Unfortunately, participation in screening programs are low with interventions only increasing participation modestly. This meta-analysis explores if intervention effectiveness can be increased by targeting specific subpopulations with specific interventions (...) or by combining interventions. Six databases were searched for studies aiming to increase participation in mail-out FOBT screening. To investigate if interventions are more effective for certain subpopulations, the difference in (log) Risk Ratios (RRs) between alternate subpopulations (male vs. female; low vs. high Socioeconomic Status (SES); <65 vs. ≥65 years) was assessed. To investigate if interventions should be combined, uptake rates for single interventions were compared to uptake rates for combined